Providers for MMA

Below is Community Care Plan's list of MMA services that require prior authorization as of December 1st, 2018.

 

Please be advised that effective January 1st, 2019, CCP will no longer accept authorization requests via fax. Providers will need to submit authorization requests via the EpicCare Link provider portal and should include all necessary clinical information.

Please note that all services rendered by out of network providers require prior authorization from Community Care Plan. For Behavioral Health and Substance Abuse services that require prior authorization, please contact Carisk Behavioral Health at 1-800-294-8642.

For cases where a participating provider in not available in our network or a non-participating provider is submitting the request, please use our Pre-Certification/Authorization Request Form, click here

ADMISSION INPATIENT and FACILITY-BASED CARE
ELECTIVE MEDICAL INPATIENT ADMISSION ELECTIVE SURGICAL INPATIENT ADMISSION
INPATIENT REHABILITATION ADMISSION NON-ELECTIVE (EMERGENCY) ADMISSION
NURSING FACILITY SERVICES SKILLED NURSING FACILITY ADMISSION
ADMISSION OBSERVATION
ADMISSION / DISCHARGE SAME DAY HOSPITAL OBSERVATION SERVICES (for any reason)
COSMETIC/ PLASTIC/ RECONSTRUCTIVE PROCEDURES
ADJACENT TISSUE TRANSFER/ REARRANGEMENT/ REPAIR INTEGUMENTARY SYSTEM BARIATRIC SURGERY
BLADDER REPAIR/ RECONSTRUCTION PROCEDURES BREAST SURGICAL PROCEDURES (excludes excisions or biopsies)
CANTHOPLASTY CONSTRUCT BLADDER OPENING
DESTRUCTION OF LESIONS EYELID, EXCISION AND REPAIR
EYELID REPAIR PROCEDURES FOOT and TOES RECONSTRUCTION
GASTRIC NEUROSTIMULATOR PROCEDURES GASTRIC PROCEDURES (including laparoscopic surgery and revision of anastomosis)
HAND AND FINGERS RECONSTRUCTION HEAD (SKULL, FACE, TMJ) RECONSTRUCTION
HEART DEFECT REPAIR (STRUCTURAL) HUMERUS AND ELBOW RECONSTRUCTION
INTRALESIONAL INJECTIONS KERATOPROSTHESIS
KNEE, ARTHROPLASTY LIP/ PALATE REPAIR
MASTOID SURGERY NECK AND THORAX RECONSTRUCTION
NOSE, REPAIR OCULAR ADNEXA, STRABISMUS SURGERY
PALATE AND UVULA REPAIR PELVIS and HIP RECONSTRUCTION
PENILE REPAIR SKIN FLAPS AND GRAFTS
CREATE TEAR SAC DRAIN DERMATOLOGIC PHOTOCHEMOTHERAPY AND LASER TREATMENT
TESTICULAR PROSTHESIS INSERTION
DENTAL CARE IN A FACILITY
Medically necessary dental services are authorized by the Prepaid Dental Health Plan (PDHP). CCP will be responsible for the prior authorization of the facility and ancillary medical services in the facility.
DIAGNOSTIC IMAGING AND LAB TESTING
CT SCAN (Requirement waived for high performing PCPs) CTA AND CALCIUM SCORING
GENETIC TESTING (no authorization is required for standard genetic tests performed on the pregnant enrollee) MRI (Requirement waived for high performing PCPs)
PET SCAN SLEEP STUDY
TRANSVAGINAL US NON-OB
DIALYSIS
HEMODIALYSIS AND PERITONEAL
DURABLE MEDICAL EQUIPMENT
(Medical and surgical supplies do not require prior authorization if the supply is a FL Medicaid covered benefit and is provided by a participating provider)
APNEA MONITOR BONE GROWTH STIMULATOR
COCHLEAR DEVICE SYSTEM CPAP AND BIPAP MACHINES
COUGH STIMULATING DEVICE CHEST WALL OSCILLATION SYSTEM
DIABETIC SHOES HOSPITAL BEDS
INSULIN PUMPS AND SUPPLIES OXYGEN DELIVERY SYSTEMS
PATIENT LIFTS SPEECH GENERATING DEVICE AND REPAIR
UNLISTED DURABLE MEDICAL EQUIPMENT WHEELCHAIRS (MANUAL AND ELECTRIC, INCLUDING ACCESSORIES)
WOUND VAC PUMPS
ELECTIVE INVASIVE PROCEDURES
ABLATE HEART DYSRHYTHM FOCUS (ELETROPHYSIOLOGICAL PROCEDURES) ABLATE INFERIOR TURBINATE
ABORTION PROCEDURES (elective) ADJUST BONE FIXATION DEVICE
ANAL PRESSURE RECORD ANAL/ URINARY EMG
ARTHROSCOPY ALL BODY AREAS AV SHUNT/ ANASTOMOSIS PROCEDURES
BRONCHOSCOPIC PROCEDURES CAPSULE ENDOSCOPY
CARDIAC CATHETERIZATION CARDIOVERSION, ELECTRICAL - INTERNAL
CARPAL TUNNEL SURGERY CATARACT SURGERY (Medically necessary cataract surgery will be authorized by 20/20 EyeCare network. CCP will be responsible for the prior authorization of the facility and ancillary medical services)
CHEMODENERVE ECCRINE GLANDS CHOLECYSTECTOMY, LAPAROSCOPIC
CIRCUMCISION (AUTH REQUIRED IF AGE > 28 days old) CORONARY THERAPEUTIC SERVICES
CYSTOMETROGRAM CYSTOSCOPY AND TREATMENT
DENERVATION DISCECTOMY/ VERTEBRAL BODY RESECTION
ELECTRICAL STIMULATION, OPERATIVE ELECTROMYOGRAPHY and NERVE CONDUCTION VELOCITY TESTING
ENDOCERVICAL CURETTAGE ENDOSCOPY, SURGICAL (SINUS, ESOPHAGUS, SMALL INTESTINE, STOMA)
EPIDURAL INJECTION FOR LYSIS EPIDURAL INJECTION FOR PAIN
ESOPHAGOGASTRIC FUNDOPLASTY EXCISION CYSTIC HYGROMA, AXILLARY/ CERVICAL
GRAFT PROCEDURES ON MUSCULOSKELTAL SYSTEM (GENERAL) HEMORRHOIDECTOMY
HERNIA REPAIR (open and laparoscopic) HYPERBARIC TREATMENT (Wound care center only)
HYSTERECTOMY (with sterilization form) HYSTEROSCOPY
IMPLANT AND REVISION OF NEUROELECTRODES IMPLANT COCHLEAR DEVICE
IMPLANT CORNEAL RING IMPLANT CRANIAL BONE GRAFT
IMPLANT EYE SHUNT IMPLANT INFUSION PUMP
INSERTION OF TUNNELED INTRAPERITONEAL CATHETER LAMINOTOMY/ LAMINECTOMY
LAPAROSCOPY OF ABDOMEN, PERITONEUM, OMENTUM MOHS SURGERY
MYOMECTOMY NEPHRECTOMY
OPTIC NERVE, DECOMPRESSION ORAL SURGERY
ORCHIECTOMY, ORCHIOPEXY OVIDUCT/ OVARY, LAPAROSCOPY
PROCTOPEXY, LAPAROSCOPIC PENILE IMPLANT (REMOVAL ONLY)
PROSTATE PROCEDURES PTERYGIUM SURGERY
SHOULDER SURGERY/ REPAIR/ REVISION/ RECONSTRUCTION SKIN GRAFTING PROCEDURES
SPIDER VEIN AND ENDOVENOUS THERAPY SPINAL IMPLANT/ PUMP/ ANALYZE
SPINE FUSION STERILIZATION PROCEDURES (with sterilization form)
STRESS TEST (THALLIUM, CARDIOLYTE ETC.) THORACOSCOPY, DIAGNOSTIC OR SURGICAL
TOTAL DISC ARTHROPLASTY (artificial disc) TRANSCATH STENT TO CAROTID ARTERY/ INCLUDING ANGIOPLASTY
TRANSCATH PERM OCCLUSION/ EMBOLIZATION PERC, OF CNS TRANSESOPHAGEAL ECHOCARDIOGRAPHY
TYMPANOSTOMY UTERINE FIBROID EMBOLIZATION
HOME HEALTH
HOME RESPIRATORY THERAPY VISITS HOME HEALTH AIDE VISITS
HOMEMAKER SERVICE PERSONAL CARE SERVICES
PRIVATE DUTY NURSING SKILLED NURSING VISITS
SOCIAL WORKER HOME VISITS
HOSPICE
HOSPICE INPATIENT HOSPICE OUTPATIENT AT HOME/ ALF/ SNF
MATERNITY (Requirement Waived for High Performing OB Providers)
DELIVERY (SCHEDULED CESAREAN AND INDUCTIONS) OBSTETRICAL CARE — PRE-NATAL PROCEDURES (Prenatal sonograms do not require prior auth)
NUTRITION SERVICES
NUTRITIONAL COUNSELING NUTRITIONAL SUPPLEMENTS/ NUTRITIONAL FORMULAS/ ENTERAL NUTRITION
ORTHOTICS AND PROSTHETICS
CRANIAL ORTHOSIS LIMB AND TORSO PROSTHETICS
ORTHOTICS/ PROSTHETICS PROSTHETIC CUSTOM EYE, SURFACING & FITTING
THERAPY AND INTEGRATIVE MEDICINE SERVICES (PT/ OT/ ST/ RT evaluations do not require prior authorization)
ACUPUNCTURE CARDIAC REHAB
MASSAGE THERAPY (Expanded Benefit—limitations apply) OCCUPATIONAL THERAPY
PHYSICAL THERAPY RESPIRATORY THERAPY
SPEECH THERAPY EQUINE THERAPY
CHIROPRACTIC SERVICES (Prior authorization required for Expanded Benefit Only — Limitations apply)
TRANSPLANT
ALL TRANSPLANT SERVICES, INCLUDING EVALUATIONS
TRANSPORTATION
AIR AMBULANCE